Ads, Not Research, Can Create Pharma Best-Sellers

$700-a-month combination pill contains $20 worth of medications

A 60-second television advertisement featuring actor Danny Glover, which ran widely late last year, concerned pseudobulbar affect (PBA), a neurological condition characterized by inappropriate, uncontrolled outbursts of laughing or crying. Although no drugs were mentioned, the ad was sponsored by Avanir Pharmaceuticals, a firm that launched Nuedexta, a pricey, brand-name medication that targets the disorder, according to Kaiser Health News (KHN).

The ad campaign has fuelled the controversy over how direct-to-consumer (DTC) advertising—typified by ads that call on viewers to “ask your doctor” about a possible treatment—takes a niche medication and promotes its use for a broad range of patients, and fosters the use of expensive prescription products when less-expensive ones might suffice, the article asserts.

The United States is one of two countries that allow advertising of prescription drugs. The other country is New Zealand.

The case of Nuedexta is noteworthy because of its price––more than $700 a month for a supply of the twice-a-day pills, which must be taken indefinitely. The drug is a combination of two low-cost ingredients—dextromethorphan (an over-the-counter cough medication) and quinidine (a generic heart drug)––that, purchased separately, would run approximately $20 a month, based on online cost estimators.

While Nuedexta is the only drug approved by the FDA for patients with PBA, doctors have successfully treated the condition with several alternatives costing far less—all antidepressants.

“The cost for mixing two old drugs together is unconscionable,” Dr. Jerry Avorn, professor of medicine at Harvard Medical School, told KHN.

Nuedexta’s sales rose from approximately $37 million in 2012 to $218 million last year, according to EvaluatePharma, which tracks pharmaceutical industry pricing and markets.

The strategic marketing of Nuedexta is part of a broader trend in which even small pharmaceutical firms turn to high-cost airwaves to encourage the use of their products, according to KHN. Pharmaceutical industry spending on DTC television ads has been on the rise—up 62% since 2012 to an estimated $6.4 billion in 2016—even as TV advertising for other product types stayed flat. By 2016, drug ads were the sixth most-common category of television advertisement—behind such things as cars and restaurants—up from 12th place five years ago.

Several of the ads, such as Nuedexta’s, promote medications for relatively unusual conditions, such as a sleep disorder that affects only people who are blind. Others address more-common conditions, such as opioid-induced constipation.

Drug makers defend the advertising onslaught as educating patients who may not understand they have a disease or that their symptoms can be treated, KHN says.

The TV ad with Danny Glover was nonbranded––meaning a drug wasn’t mentioned—and therefore it wasn’t required by the FDA to list adverse events and risks. Instead, it simply suggested that individuals with PBA ask their doctors about treatment or go to a website to learn more about the disease. Awareness among primary care doctors and patients rose to 72% and 52%, respectively.

“It was an extremely successful campaign,” Lauren D’Angelo, senior director of marketing for Avanir, told KHN. “We drove a lot of patients into doctors’ offices. The challenge was they did not ask for Nuedexta by name.”

For sales, that was a problem. So this year the company unveiled a new TV advertising campaign, which features a man inexplicably bursting into tears at a child’s birthday party. It intends to move potential customers beyond “could you have PBA?” to “ask your doctor for Nuedexta.”

“We are mimicking what we want them to do, to ask about PBA and ask about Nuedexta,” D’Angelo said.

There’s a good reason for this kind of messaging, according to KHN. In a 2016 poll conducted by Medscape, for example, 62% of physicians said they would or might prescribe an innocuous treatment to a patient who didn’t need it but demanded it.

Source: Kaiser Health News; May 16, 2017.